Although unintentional injuries have been the leading cause of death for children and adolescents for decades, injury prevention remains an orphan in the world of child health.
“If a disease were killing our children at the rate that unintentional injuries are, the public would be outraged and demand that this killer be stopped,” said former Surgeon General C. Everett Koop, M.D., Sc.D.
Drowning is the loneliest among all the orphans, sitting neglected in a corner.
In the last decade, drowning has killed more children ages 1-4 years than any other cause of injury death, according to the Centers for Disease Control and Prevention. An average of about nine preschoolers and 10 kids ages 5-19 years drown each week.
As we head into the warmer months, we will see drownings increase, as we do every year.
What do you know about how kids drown in your community? What can you do to help prevent tragedy this year?
Drowning is different in each community, and risk factors vary by a child’s age, developmental status and exposure to water. The multifactorial nature of drowning means one thing will never prevent it, so we need to use layers of protection.
The AAP policy statement Prevention of Drowning (https://doi.org/10.1542/peds.2019-0850) reviews these layers and describes approaches in the exam room or at the bedside to help parents and caregivers implement them. The policy also discusses community interventions and advocacy opportunities.
Layers of protection include close, capable and constant adult supervision; swim lessons/water competence training for kids older than 1 year; use of Coast Guard-approved flotation devices; barriers to prevent access to water, including four-sided fencing with a locking gate around pools and spas; and CPR training for rescue in the event of a drowning.
Where and how kids and teens drown vary by geography. In Oregon, where I live, almost all drowning events occur in lakes and rivers. In Phoenix, the overwhelming majority occur in swimming pools. In Florida, water is everywhere and so are drowning threats. Knowing the epidemiology in your community can help you tailor your messaging and partner with community organizations to help your families protect their kids.
While drowning is a threat to all communities, several groups deserve special attention.
Among toddlers ages 1-4 years, drowning remains the leading cause of injury death. Pediatricians know how quick and impulsive toddlers can be and that enforcement of rules and supervision are insufficient to influence their actions. Standing water, be it a pool, pond or river, is a source of great fascination. Therefore, water competence training and physical barriers to water access are essential for families whose toddlers spend time in homes near water.
Tragically, around 70% of toddler drownings occur outside of swim time, when kids are not expected to be in or around water. I have worked with dozens of families who have lost toddlers to drowning. One common plea they have for pediatricians is to ensure patients’ parents and caregivers are aware of the constant threat water represents. If you do not talk routinely about drowning yet, please integrate it into your anticipatory guidance.
Among older kids, we see significant disparities in drowning, with Black and American Indian/Alaska Native youth having significantly higher rates of drowning than other populations, especially in adolescence. Much of this is attributable to lack of access to swimming lessons or water competence training. I believe water competence should be considered an essential life skill, and all children should have the opportunity to learn how to protect themselves in the water like is done with driver’s training. We must work with community partners to help improve access to swim lessons for kids at risk.
Finally, drowning rates are significantly higher for children and youth with special health care needs, especially neurodivergent kids and adolescents and those with seizure disorders. Building awareness and supporting programs to help address these kids’ needs can save lives.
While I am an injury prevention nerd, I am not asking you to become passionate about my interests. Rather, I hope this gentle nudge will spur you to integrate some component of drowning prevention into your practice.
The AAP has resources to help you address the epidemic of drowning in your community at https://www.aap.org/drowning.
